Heart defects that increase pulmonary BF (L-R shunt)

1. PDA (Patent Ductus Arteriosus)

1.1. cause: persistent fetal circulation in premies (< 37 weeks)

1.2. "machinery" murmur/thrill in pulmonic area

1.3. normal for newborns ductus to close by 2-3 days -> PDA if it doesn't close during this time.

1.4. TX: surgery @ 2-4 months for mitral valve replacement/patch, transcatheter closure, thorascopic surgery/clip ligation, IV ibuprofen and indomethacin to close PDA (don't use if CHF present/term infants)

1.5. risk for respiratory infections/pneumonia

1.6. asymptomatic

1.6.1. if symptomatic you will see tachypnea, tachycardia, full bounding pulses, intercostal retractions, poor growth, CHF, (large PDA)

1.7. DX: CXR, ECG- left ventricular hypertrophy

1.8. connection of aorta and pulmonary artery

1.9. no long term complications

2. S/s for all: tachypnea, tachycardia, CHF, acrocyanosis ( pink baby

3. VSD (Ventricular Septal Defect)

3.1. opening in ventricles

3.2. systolic murmur heard at 3rd/4th L intercostal space @ sternal border

3.2.1. thrill present

3.3. small VSDS= no s/s

3.4. large VSDS = CHF, poor growth, decrease exercise intolerance, increased pulmonary infections/HTN

3.5. down syndrome pts

3.6. DX: CXR, ECG

3.6.1. CXR for large opening= enlarged heart and pulmonary vascular markings w/shunting

3.7. should usually close within 6 months

3.7.1. If unable to close, surgery at 6 months-1 y/o unless CHF cannot be managed

3.8. TX: surgery, cardiac cath, pacemaker

3.8.1. Complications: arrhthymias, infection, R branch block or heart block

4. ASD (Atrial Septal Defect)

4.1. opening between atriums

4.2. soft systolic ejection murmur

4.3. listen for S2 splitting @ pulmonary area

4.4. asymptomatic

4.5. no activity limitations

4.6. large ASD risk for CHF, poor growth, tire easily, arrythmias, pulmonary artery HTN

4.7. DX: enlarged R ventricle by accident

4.8. Cardiac catheterization, surgery w/occlude, aspirin 81 mg post op

4.9. Middle aged adults w/no tx risk for stroke d/t PE

4.10. seen in down syndrome pts